Transgender men and women
Transgender people are at increased levels of risk of exposure to HIV due to lower levels of knowledge around transmission, as well as other factors such as how to negotiate safe sex, how to access post-exposure prophylaxis and. treatment options.
This knowledge factor, compounds other social and political issues that increase risk for TG people. Stigma, discrimination, lack of training amongst healthcare personnel, as well as barriers to income all creates vulnerability around TG people with regard to HIV.
Compounding this is the shortage of HIV campaigns that target trans people in order to empower them. Bockting et al (1998), Dewey (2008), Kenagy (2002) and Nemoto et al (1999 and 2004) all find TG people have lower levels of HIV knowledge and thus increased risk[i],[ii],[iii],[iv]. Kenagy has been able to identify that female to male (FTM) transgender people have significantly lower levels of AIDS knowledge than male to female (MTF) transgender people. [v]
Although the limited research in this group shows greater vulnerability, little research has been done to provide advocates with empirical evidence to demand grater inclusion. Demonstrative of this is the lack of an indicator which reflects the knowledge levels of TG men and women in the UNGASS reporting process.
However, a few countries did report on transgender issues in the 2010 reporting round. The UNGASS process does ask countries to identify their vulnerable populations and some countries, most especially in Latin America and South East Asia have done exactly this.
Argentina states in the 2010 report that in their project on Strengthening Epidemiological Surveillance Study on HIV for Transgender People that there is a need for more research. They acknowledge that “from the standpoint of health, there are few transgender-focused activities aimed at prevention in general, and against HIV / AIDS and STIs in particular. In addition, access to care for the disease of HIV / AIDS may be limited due to low socio-economic status, to shame to expose the status of trans people, and the lack of knowledge and information about HIV / AIDS.” A strong component of the strategy of Argentina is to improve the information and data available on the epidemic in the country. Transgender people are included in the list of vulnerable populations targeted for campaigns to increase knowledge.
Argentina also reports on a study on the Conditions of Vulnerability to HIV/AIDS and Problems of Accessing Health Care for Gay and Trans people in Argentina. The study aims to understand the issues and although Argentina is leading the way in doing this kind of work, we hope to see larger studies with larger sample sizes in the future. Argentina also speaks to the need to recognize the human rights of transgender people and not just the epidemiological issues.
Uruguay
Country report in 2010 Uruguay mentions that in October 2009 Uruguay passed Law 18.620 which acknowledges the right to gender identity and to change one’s name and gender in order to fully and freely develop one’s personality. This should be commended as a laudable step from Uruguay in establishing equality. Uruguay also states that because the country has a concentrated epidemic, epidemiological studies have now recently begun in 2008 on knowledge, practices for trans, as well as MSM and MSW.
Malaysia
The country report for Malaysia refers to the fact that “The situation affecting transgender persons is relatively well known through contemporary local studies of this population. [...] Though the level of HIV and AIDS knowledge in this community remains low, condom use during transactional sex is often observed by transgender sex workers as indicated by the IBBS (condom use with last client was 95%).Despite the findings of studies concerning transgenders which have indicated that the issue of HIV vulnerability in this community is critical, outreach and interventions with this group remain challenging. There are a number of comprehensive programmes which been made available to address this concern.”[i] Certainly a sign that Malaysian leadership is beginning to show progress, whether this is government or civil society led is questionable as worryingly, the report also reminds us that “transgender persons can be charged with indecent behaviour under Minor Offences Act 1955, if they are found to be cross-dressing. The term ‘indecent behaviour’ has not been defined in the Act, and therefore, it is up to the discretion of the police to determine what constitutes ‘indecent’ behaviour. They can also be detained by religious authorities.”[ii] The report does not address implementation of the law.
All too often transgender people are grouped with other vulnerable groups, and although there may exist some crossovers there needs to be specifically taregetd prevention efforts globally to both MTF and FTM transgenders. And these efforts should be considered a matter of urgency.